'Cancer risk' for transplant patients

Surgery that saves lives can also incease the chance of people developing tumours. Celia Hall reports

Transplant patients have an increased chance of developing cancer years after their surgery and should be monitored for early signs, a surgeon says today.

Writing in the Lancet, Mr Peter Lodge, consultant renal surgeon and head of kidney and pancreatic transplants at St James's Hospital in Leeds, West Yorkshire, says that after 20 years the risk of developing a cancer is 40 per cent compared with 6 per cent among people who have not received transplants.

"Although any cancer is serious, fortunately the cancers seen most commonly are skin cancers, which can be removed and cured," he said yesterday.

However, Mr Lodge added that the risks also existed for other solid-organ cancer, such as hearts and livers.

In the Lancet, Mr Lodge reports that out of 918 adults and children who have had successful kidney transplant operations in Leeds, 70 (7.6 per cent) developed cancer. Of these 42 were skin cancers, both squamous cell and basal cell carcinomas, but not the more dangerous melanoma.

Ten patients developed more than one cancer. While no cancers were seen in children who had had transplants, there was a "disturbing number of tumours in the age group 15-35 years", he reports.

The study covers 24 years since the hospital began kidney transplantation. The immunosuppressant drug cyclosporin, which helps to prevent the body rejecting the new organ, was introduced in 1984. It can be taken for life.

In the Leeds group, only 34 per cent of the 70 who developed cancer had taken the drug compared with 62 per cent of the patients who had not developed tumours.

Mr Lodge says in the report that there was no evidence that cyclosporin increased or decreased the cancer risk, but it might be a factor over time.

Yesterday, the surgeon said that another possibility was that a cancer- causing virus might be able to establish itself in transplant patients.

"The overall message is that we should be looking for signs of cancer early. There should be overall surveillance for transplant patients."

Mr Lodge added that the risk of skin cancer in transplant patients has been well documented in Australia.

"I wanted to highlight the fact that this is also a problem for northern Europe," he said.

Mr Lodge said physicians were now starting to tell patients about a possible future risk. He said when transplant patients in Australia developed skin cancer some of the patients had the kidney removed, and the tumour went.

"They have chosen to go back on to dialysis," he said. "Other patients decide to accept that they will have the skin lesions removed when they occur. But there is a choice, at least a choice, for kidney-transplant patients."

About 1,750 people a year in the United Kingdom and Ireland receive kidney transplants. Overall, the operation is successful. After one year with a first trans- plant, 92 per cent of patients survive; over five years, 79 per cent survive.

Dr Leo Kinlan, director of the Cancer Research Campaign Epidemiology Unit at Oxford, said that good transplant units check patients for skin cancer.

"People have transplants for life-threatening conditions. Even given the cancer risk, having the transplant weighs very strongly in the balance of saving a life."

He said that the viral cause was suspected, adding: "The list of cancers, including cancer of the cervix, the liver and Karposi's sarcoma, associated with kidney transplant patients contains nearly all the tumours we associate with cancer-causing viruses."